| NPI | 1831328103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1756) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 2365) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 802) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2020-05-21 |