| NPI | 1659315406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 293) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 22218) |
| 101YP2500X Counselor, Professional (Licence: AL 2309) | |
| 101YP2500X Counselor, Professional (Licence: LA 1570) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2007-07-08 |