| NPI | 1457771230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT LAC-LIC-3401) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MT BBH-PCLC-LIC-25856) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2019-06-06 |