| NPI | 1447557293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 001993) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 000772) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |