| NPI | 1437530391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ND 1762) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ND 839-6-1-15A) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2015-12-29 |