| NPI | 1477888741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P0710061) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AR 0264L) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2021-01-26 |