| NPI | 1013240746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0130451) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0093101) |
| 101YP2500X Counselor, Professional (Licence: NM 0130451) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2013-11-15 |