| NPI | 1184172777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 5529) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 7046) |
| 101YP2500X Counselor, Professional (Licence: OR C4355) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2017-01-29 |