| NPI | 1114132958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 523) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2399) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |