| NPI | 1912236845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15594-132) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 1016-226) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2011-10-20 |