| NPI | 1720087190 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM 0064791) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 005706) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |