| NPI | 1144343567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC-6245) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC-6804) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2021-12-22 |