| NPI | 1487710547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 270) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 3639) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2008-05-16 |