| NPI | 1780064956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 3234-226) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16085-132) |
| 101YM0800X Counselor, Mental Health (Licence: WI 3234-228) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2019-01-18 |