| NPI | 1073609186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5338) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2491-A) |
| 101YM0800X Counselor, Mental Health (Licence: NC 5338) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-05-13 |