| NPI | 1871201152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN C2-5180) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: IN C2-5180) |
| 106S00000X Behavior Technician (Licence: IN C2-5180) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2022-11-07 |