| NPI | 1235307729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 146L00000X Emergency Medical Technician, Paramedic | |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2010-02-26 |