| NPI | 1487618211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE 112) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DE 4331) |
| 101YP2500X Counselor, Professional (Licence: DE PC-0000008) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-08 |