| NPI | 1578887873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist | |
| 103T00000X Psychologist | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103TR0400X Psychologist Rehabilitation | |
| 104100000X Social Worker | |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2012-11-02 |