| NPI | 1144451436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 993) |
| 101YM0800X Counselor, Mental Health (Licence: NE 4326) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2024-03-27 |