| NPI | 1134518905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 4498) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA I0147) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 4759) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FAC-K1308300929) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2015-01-16 |