| NPI | 1306122502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1567) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 7831) |
| Enumeration Date | 2011-11-01 |
| Last Update Date | 2013-06-04 |