| NPI | 1396994927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3379) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR NCC 265054) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR MAC 507626) | |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2015-12-28 |