| NPI | 1063652600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14757-130) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2010-10-04 |