| NPI | 1316106313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1311) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4447) |
| 101YM0800X Counselor, Mental Health (Licence: NC S7046) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 533) | |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2011-09-14 |