| NPI | 1962873612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 23-05-20275) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR G17-P-01) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-05-19 |