| NPI | 1417114950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0718000097) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA095) |
| 101YP2500X Counselor, Professional (Licence: DC PRC217) | |
| 101YP2500X Counselor, Professional (Licence: VA 0701003368) | |
| 101YP2500X Counselor, Professional (Licence: MD LC0891) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2008-05-21 |