| NPI | 1851752455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 10917) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WI 10917) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2016-03-10 |