| NPI | 1154524197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 11438-132) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 2948-125) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-07-08 |