| NPI | 1417025693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VT 000191) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VT 0680000406) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-10 |