| NPI | 1043558091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5676) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7579) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 508445) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 1311266) | |
| 101YP2500X Counselor, Professional (Licence: SC 3408) | |
| Enumeration Date | 2013-01-26 |
| Last Update Date | 2016-06-01 |