| NPI | 1295020873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3747) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1077) |
| 101YP2500X Counselor, Professional (Licence: TX 18075) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2011-06-13 |