| NPI | 1417096017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2012-11-30 |