| NPI | 1487998522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 8743) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 8743) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 22065) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-08-25 |