| NPI | 1245638956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1000000015350) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1000000014991) |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2014-12-11 |