| NPI | 1093892515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH 60024561) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 75551) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 156855) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 9787) | |
| 101YP2500X Counselor, Professional (Licence: IL 178.002744) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-02-05 |