| NPI | 1538344908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 819) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1770) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3523) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2012-05-09 |