| NPI | 1568507952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC0006578) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO ACC0006578) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2022-07-21 |