| NPI | 1649506031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 2389) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT CAC-5526) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000983) | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2015-05-13 |