| NPI | 1801019997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ND 841-6-15-15-361) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ND 1678) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2020-09-03 |