| NPI | 1609027937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3241) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 9257) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9257) | |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2019-07-23 |