| NPI | 1083818306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NM 0122291) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 0092471) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2010-02-08 |