| NPI | 1700964277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD 0686) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC OO84) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |