| NPI | 1033259676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1584-132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 1773-123) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-07-09 |