| NPI | 1912955071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7469) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1906) |
| 101YP2500X Counselor, Professional (Licence: NC S7469) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-07-03 |