| NPI | 1871251553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 247000000X Technician, Health Information |
| Enumeration Date | 2021-11-30 |
| Last Update Date | 2022-10-03 |