| NPI | 1467525683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE LMHP # 228) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE LADC # 117) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-08 |