| NPI | 1265481956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA C-2903) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA LADC1-1364) |
| 101YM0800X Counselor, Mental Health (Licence: MA LM4281) | |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2007-07-08 |