| NPI | 1245537588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACC-7103) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC-5666) |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2015-08-24 |