| NPI | 1891233847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA437) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC2085) |
| 101YP2500X Counselor, Professional (Licence: MD LC2028) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2018-03-17 |