| NPI | 1629368444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1739) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 00111768) |
| 101YP2500X Counselor Professional (Licence: NC A7757) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2011-04-13 |