| NPI | 1871619494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 2284) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: CO 4447) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2008-01-08 |