| NPI | 1013421130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TN LDC0000000722) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TN 722) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2019-04-15 |