| NPI | 1811066640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A3619892) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |