| NPI | 1255629754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9591) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2037) |
| 101YP2500X Counselor, Professional (Licence: NC A9591) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2017-05-11 |