| NPI | 1215107099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000476) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CT 000061) |
| 101YM0800X Counselor Mental Health (Licence: MA 3665) | |
| 101YP2500X Counselor Professional (Licence: CT 000061) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2008-03-07 |