| NPI | 1700863206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD SDLPCMH2032) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD SDCCDCIII1051148) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2021-05-06 |