| NPI | 1083636252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 11932) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 3161-125) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |