| NPI | 1457456378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0011523) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0020788) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-10-20 |