| NPI | 1932768553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 2470A2800X Technician, Health Information, Assistant Record Technician |
| 246Y00000X Spec/Tech, Health Info | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2022-09-27 |