| NPI | 1013034248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 6854217-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WY PPC-1179) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-04-28 |