| NPI | 1366749368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0763) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MS 0763) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 0763) | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2011-02-28 |