| NPI | 1821229576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 00082652) |
| 101YM0800X Counselor Mental Health (Licence: NC 7367) | |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2011-01-13 |