| NPI | 1003063454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC A13735) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 24166) |
| 101YM0800X Counselor, Mental Health (Licence: NC A13735) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2018-02-08 |