| NPI | 1336467299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OK 4800) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 1003) |
| 101Y00000X Counselor | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2018-05-16 |