| NPI | 1326316886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000951) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 002448) |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2024-04-11 |