| NPI | 1205379500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 17353-130) |
| 101YM0800X Counselor, Mental Health (Licence: WI 2718-226) | |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2016-11-18 |