| NPI | 1740568625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC MHL079119) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC MHL079119) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2011-07-27 |