| NPI | 1093886277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 4485) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 5488) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1049) | |
| 101YS0200X Counselor School (Licence: NC 6750) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2018-07-04 |