| NPI | 1871757617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 9607788) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 9607788) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-10 |