| NPI | 1396069134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7876) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7876) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1698) | |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2019-11-25 |