| NPI | 1346371135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 2805) |
| Additional Taxonomies | 251B00000X Case Management (Licence: MO 2805) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2010-05-11 |