| NPI | 1720258593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 5035) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 1325) |
| 101YM0800X Counselor, Mental Health (Licence: AR 1325) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2021-09-20 |