| NPI | 1366636003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6230) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1391) |
| 101YP2500X Counselor, Professional (Licence: NC 6560) | |
| 101YP2500X Counselor, Professional (Licence: MO 2009024347) | |
| 101YP2500X Counselor, Professional (Licence: TX 73929) | |
| 101YP2500X Counselor, Professional (Licence: KS 2754) | |
| 101YP2500X Counselor, Professional (Licence: NM 0174701) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2015-07-17 |