| NPI | 1770839144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY 589) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2014-08-27 |