| NPI | 1417386566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3527A) |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2013-11-08 |