| NPI | 1144564659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CO LPC.0012288) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO ACD.0000529) |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2022-07-21 |