| NPI | 1538392105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 801) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9267) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2013-10-03 |