| NPI | 1962713065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC S8594) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2562) |
| 101YP2500X Counselor, Professional (Licence: SC 9624) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2024-09-20 |