| NPI | 1164446100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000386) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 002714) |
| 101YP2500X Counselor Professional (Licence: CT 000015) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |