| NPI | 1508096462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A 4002607) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 110689) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2009-07-24 |