| NPI | 1104092733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 1201) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 25033) |
| 101Y00000X Counselor (Licence: IN R831) | |
| 101Y00000X Counselor (Licence: WA 2848) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 12225) | |
| 101YM0800X Counselor Mental Health (Licence: FL 50357) | |
| Enumeration Date | 2008-05-04 |
| Last Update Date | 2008-05-04 |