| NPI | 1063597755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 682) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2449) |
| 101YP2500X Counselor, Professional (Licence: NE 1380) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2011-12-16 |