| NPI | 1780757922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3083) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 238) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-04-13 |