| NPI | 1396974283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 3299-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1772-132) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 7107-135) | |
| 101YM0800X Counselor, Mental Health (Licence: WI 3299-125) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |