| NPI | 1386943421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 981) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 5200) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2011-03-15 |