| NPI | 1568683670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14060131) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 682125) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2008-04-10 |