| NPI | 1922172105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 367) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 2496) |
| 101YP2500X Counselor Professional (Licence: NE 1357) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-09-05 |