| NPI | 1952030793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0701011585) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0704013133) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-07-19 |