| NPI | 1457580847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 7472) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1486) |
| 101YM0800X Counselor Mental Health (Licence: NC 7472) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2013-07-28 |