| NPI | 1134356116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 743) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 4420) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2012-08-14 |