| NPI | 1104937895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 667) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 551) |
| 101YM0800X Counselor Mental Health (Licence: NE 2326) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-04-12 |