| NPI | 1376968834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 1947-132) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: WI 1587-125) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2014-02-20 |