| NPI | 1518389626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1492) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 5377) |
| 101Y00000X Counselor (Licence: LA 302349) | |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2016-03-22 |