| NPI | 1922580646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 06790-C) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 02376-I) |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2022-12-06 |