| NPI | 1639202963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 847) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C002983) |
| 101YM0800X Counselor, Mental Health (Licence: NC 825) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2012-12-20 |