| NPI | 1487762779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 0155921) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 3801) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2024-01-04 |