| NPI | 1326161118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 3688) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 826) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-03-06 |