| NPI | 1124037270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6231) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 3085) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |