| NPI | 1417158510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1737) |
| Additional Taxonomies | 251B00000X Case Management (Licence: MA 1737) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |