| NPI | 1114237294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 372600000X Adult Companion |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2010-10-21 |