| NPI | 1972983096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-11-25) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2017-01-04 |