| NPI | 1932756038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 0151611) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM CAD0218661) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2021-09-15 |