| NPI | 1386799112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH2187) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 08111375) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2010-09-22 |