| NPI | 1518239128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 11055) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 006858) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2013-08-01 |