| NPI | 1457531519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1601) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 5251) |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2016-04-29 |