NPI | 1235488362 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012768) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000433) |
103T00000X Psychologist | |
Enumeration Date | 2012-09-05 |
Last Update Date | 2018-06-21 |