| NPI | 1063404135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 697) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE LA DC 579) |
| 101YM0800X Counselor, Mental Health (Licence: NE 1481) | |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2016-09-29 |