| NPI | 1376844415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 10322) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2010-11-05 |