| NPI | 1437370145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY MA, LAT-258) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY MA, LAT-258) |
| 101YM0800X Counselor, Mental Health (Licence: WY MA, LAT-258) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT-258) | |
| 101YM0800X Counselor, Mental Health (Licence: WY MA,LAT#258) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2016-09-13 |