| NPI | 1336311208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 3170) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 3170) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2023-08-30 |