| NPI | 1083045512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 4108) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 4108) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2016-06-02 |