| NPI | 1366745937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 4528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 612) |
| 101YP2500X Counselor, Professional (Licence: NE 2202) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2016-04-07 |