| NPI | 1881611572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1132) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ND R16926) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-04-22 |