| NPI | 1215306253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NM C-09082) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM 0126741) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2015-09-21 |