| NPI | 1407930944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 35) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE 296) |
| 101YP2500X Counselor Professional (Licence: NE 621) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-02-18 |