| NPI | 1386025922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3419) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 952) |
| 101YP2500X Counselor, Professional (Licence: NC 8762) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2023-06-21 |