| NPI | 1356777239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 973-8-15-18A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1715) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2024-03-19 |