| NPI | 1922342955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1692) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 850-10-1-15A) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2017-01-24 |