| NPI | 1285765925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 16603-132) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 0269AD) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 619) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2022-08-10 |