| NPI | 1093912305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2007-07-08 |