| NPI | 1154497220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1061) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 6860) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 10014) | |
| 101YM0800X Counselor Mental Health (Licence: NC 6860) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-10-23 |