| NPI | 1194193359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 22144) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 11862) |
| Enumeration Date | 2015-09-04 |
| Last Update Date | 2019-12-18 |