| NPI | 1568764710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7589) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101Y00000X Counselor | |
| Enumeration Date | 2010-11-20 |
| Last Update Date | 2011-11-11 |