| NPI | 1407090830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2004035839) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 3275) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-04-29 |