| NPI | 1205826195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 2254) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CO 1440) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2020-06-01 |