| NPI | 1790088615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH CC2386) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH CCS4336) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2010-12-15 |