| NPI | 1093057820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 0965) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2019-01-17 |