| NPI | 1083921720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2016-02-22 |