| NPI | 1548670714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 13-12-34) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2017-07-31 |