| NPI | 1356458368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 15710) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 5336) |
| 101YP2500X Counselor, Professional (Licence: CO 2916) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2020-05-05 |