| NPI | 1417275173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 803) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 803) |
| 101YM0800X Counselor, Mental Health (Licence: MS 803) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2010-05-05 |