| NPI | 1043696032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 5544) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 5544) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2015-08-03 |