| NPI | 1447472154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA CCGC # 10) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 241) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC NCAC II 005656) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-09-11 |