| NPI | 1376664359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 736) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-13148) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-13219) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 650) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2016-02-05 |