| NPI | 1295245892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 150864) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC.0998550) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NJ LPCC0015677) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0015093) | |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2021-03-19 |