| NPI | 1376661157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1106045) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0288L) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2011-07-11 |