| NPI | 1467884403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 83066) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A10218) |
| 101YP2500X Counselor, Professional (Licence: NC 10218) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3485-A) | |
| Enumeration Date | 2013-08-01 |
| Last Update Date | 2021-08-12 |