| NPI | 1811096498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 153C) |
| 101YP2500X Counselor, Professional (Licence: MA 1410) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 0555) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2009-04-02 |