| NPI | 1467578021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NH 641) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: UT 3419076004) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-08-13 |