| NPI | 1386767218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA029) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC0392) |
| 101YP2500X Counselor, Professional (Licence: MD LC0392) | |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2007-07-08 |