| NPI | 1023413812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 001270) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 001270) |
| 101YM0800X Counselor Mental Health (Licence: CT 001270) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2018-03-22 |