| NPI | 1922661693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2022-08-10 |