| NPI | 1235187196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA PC000193) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC000193) |
| 101YM0800X Counselor Mental Health (Licence: PA PC000193) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2015-04-28 |