| NPI | 1073584629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 11814) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 911) |
| 101YM0800X Counselor, Mental Health (Licence: NC 861) | |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-07-08 |