| NPI | 1558761627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1765-13) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: HI 1765-13) |
| 101YP2500X Counselor, Professional (Licence: HI 1765-13) | |
| 103K00000X Behavior Analyst (Licence: HI 1765-13) | |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2014-08-26 |