| NPI | 1124232897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 722) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3325) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2023-10-05 |