| NPI | 1528484235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 7081-125) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 12067) |
| 101YP2500X Counselor, Professional (Licence: TX 65633) | |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2020-07-31 |