| NPI | 1336294768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2013-05-15 |