| NPI | 1942974381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 6546) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN 6546) |
| Enumeration Date | 2021-08-08 |
| Last Update Date | 2024-03-20 |