| NPI | 1376902825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 15-09-15) |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2019-02-12 |