| NPI | 1306148259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C3278) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 11-06-64) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2016-01-28 |