| NPI | 1831648005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA LPC: 3435) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC: 1237) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2016-09-28 |