| NPI | 1336304880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 45) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 2868) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2008-08-06 |