| NPI | 1144394180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2987) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 0013) |
| 101YP2500X Counselor, Professional (Licence: NE 1547) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2008-01-23 |