| NPI | 1174905210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C4480) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2017-04-20 |