| NPI | 1023283520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: VA PPS-0601472) |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2019-02-01 |