| NPI | 1316277015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8491) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 22224) |
| 101YP2500X Counselor, Professional (Licence: NC 8491) | |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2021-05-12 |