| NPI | 1033693049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0008217) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0106063) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |