| NPI | 1396987467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 765) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2951) |
| 101YP2500X Counselor, Professional (Licence: NE 1532) | |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2009-04-03 |