| NPI | 1215113360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 3195) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 3195) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 3195) | |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2008-01-18 |