| NPI | 1912777996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-PCLC-LIC-64476) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-62848) |
| Enumeration Date | 2024-01-02 |
| Last Update Date | 2024-04-03 |