| NPI | 1730280397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 502094) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 00-0075) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS LH0602) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |