| NPI | 1578770053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: PA SW124491) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2007-07-08 |