| NPI | 1760540694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 97-R-10) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2012-01-11 |