| NPI | 1285085779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-234233) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VA 0718000420) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0710103300) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 1436) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC Csac20095) | |
| Enumeration Date | 2016-06-25 |
| Last Update Date | 2020-07-21 |