| NPI | 1881159119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251K00000X Public Health or Welfare |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2025-03-22 |