| NPI | 1366629990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101Y00000X Counselor | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-11-19 |