| NPI | 1932207222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ 10680) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AZ 10680) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-10-19 |