| NPI | 1285852533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 472) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC s2918) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2013-07-31 |