| NPI | 1558459354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 2502) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 2502) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 2502) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-05-18 |