| NPI | 1184616724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE CPC 994) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE CCGC 002) |
| 101YM0800X Counselor, Mental Health (Licence: NE LMHP 1627) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2007-07-08 |