| NPI | 1124454723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401017091) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6401013879) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MI 6401017091) | |
| 101YM0800X Counselor Mental Health (Licence: MI 6401013879) | |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2019-03-21 |