| NPI | 1982986840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 8955) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2836-A) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2013-07-26 |