| NPI | 1215340864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 1082) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 246ZE0500X Specialist/Technologist, Other, EEG (Licence: CO E6050) | |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-03-12 |