| NPI | 1497081681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-4875) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 160) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 205596) | |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2011-12-14 |