| NPI | 1760701692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DE PC-0000660) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 005151) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE CD-0000065) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2014-08-20 |