| NPI | 1437467925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1550) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 3267) |
| Enumeration Date | 2010-09-17 |
| Last Update Date | 2016-11-18 |