| NPI | 1417285883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WY 172) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WY 172) |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2015-03-04 |