| NPI | 1427215342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001712) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 13R029) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 1008) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 3949) | |
| 101YP2500X Counselor, Professional (Licence: NE 2432) | |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2023-03-17 |