| NPI | 1407189004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 7086) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1259AD) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 2157) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2009-09-14 |