| NPI | 1073729448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC LPCS #5318S) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS 1021) |
| 101YP2500X Counselor Professional (Licence: NC LPC 5318) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC CCS #459) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2012-02-26 |