| NPI | 1184873804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 21R028) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 7544) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11618-1121) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 37377) | |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2022-05-13 |