| NPI | 1265607220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN LDC0000000411) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA NCAC 001390) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |