| NPI | 1134346463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NH 311) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 0282) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-06-14 |