| NPI | 1194978601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6707) |
| 101YM0800X Counselor, Mental Health (Licence: CO 6302) | |
| 101YP2500X Counselor, Professional (Licence: CO 6302) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2021-02-11 |