| NPI | 1740523984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC LPCA # A9781) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCASA # 3068-A) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2013-04-05 |