| NPI | 1043372071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 2814) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 1199) |
| 174400000X Specialist | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2024-04-29 |