| NPI | 1609147404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000650) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 001961) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2015-02-05 |