| NPI | 1811922651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 701002755) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 718000055) |
| 101YP2500X Counselor, Professional (Licence: NC 5588) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2012-01-04 |