| NPI | 1083670491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA CAC NUMBER 0808) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC0001391) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |