| NPI | 1295761872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 701003076) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 701003076) |
| 101YP2500X Counselor, Professional (Licence: VA 701003076) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2022-07-21 |