| NPI | 1134516230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2016-12-27 |