| NPI | 1689975286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 900) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-876) |
| 101YM0800X Counselor, Mental Health (Licence: NE 8800) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 952) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 1950) | |
| Enumeration Date | 2010-11-12 |
| Last Update Date | 2013-05-09 |