| NPI | 1083642110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 1248) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MO 2002012508) |
| 101YP2500X Counselor, Professional (Licence: MO 2002012508) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2007-07-09 |