| NPI | 1457695298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 9455) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 9455) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 20293) | |
| 225C00000X Rehabilitation Counselor (Licence: NC 00115237) | |
| Enumeration Date | 2012-11-17 |
| Last Update Date | 2016-03-09 |