| NPI | 1447482336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 96-10-156) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2013-05-24 |