| NPI | 1366560369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P9908021) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0056L) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2007-07-08 |