| NPI | 1962766345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 9193) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2750) |
| 101YP2500X Counselor, Professional (Licence: CRC 00114385) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2019-06-11 |