| NPI | 1497095673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 1497095673) |
| Enumeration Date | 2013-02-25 |
| Last Update Date | 2013-08-30 |