| NPI | 1013258920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY 1159) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY 1159) |
| 101YM0800X Counselor, Mental Health (Licence: WY 1159) | |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |