| NPI | 1285640581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 4917) |
| Additional Taxonomies | 251S00000X |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2010-09-02 |