| NPI | 1215153960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 172) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PR 796) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |