| NPI | 1457582512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60113447) |
| 101YP2500X Counselor, Professional (Licence: ND 624-2-1-09) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LASAC-13106) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2010-04-09 |