| NPI | 1194860759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 007674) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1658) |
| 101YP2500X Counselor, Professional (Licence: NC 4985) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2020-09-16 |