| NPI | 1306359757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 003432) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 001195) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2018-11-28 |