| NPI | 1376736157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 05R076) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS AD05-020C) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 1381) | |
| 101YM0800X Counselor, Mental Health (Licence: AL 339002147) | |
| 101YP2500X Counselor, Professional | |
| 171M00000X Case Manager/Care Coordinator (Licence: AL 339002147) | |
| 174400000X Specialist (Licence: MS P04-003C) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2009-01-30 |