| NPI | 1518116920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC LPCS-S7461) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CCS-1553) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-205930) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2013-06-12 |