| NPI | 1144578725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: NH 0878) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 0878) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2014-07-03 |