| NPI | 1508093097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 649) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 835) |
| 101YM0800X Counselor Mental Health (Licence: NE 3526) | |
| 101YP2500X Counselor Professional (Licence: NE 1771) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2015-09-17 |