| NPI | 1528298635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2023-04-21 |