| NPI | 1174996979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 18-10-14) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2018-12-03 |