| NPI | 1457500696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 3499) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC 786) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 057) | |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2008-09-11 |