| NPI | 1720098502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1146) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC S3946) |
| 101YP2500X Counselor, Professional (Licence: NC S3946) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-02-13 |