| NPI | 1205973179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 372600000X Adult Companion |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |