| NPI | 1013943521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 1522) |
| Enumeration Date | 2006-06-25 |
| Last Update Date | 2010-03-17 |