| NPI | 1215202023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1407) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-03-12 |