| NPI | 1588701791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 457) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 769) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 0918AL) | |
| 101YM0800X Counselor Mental Health (Licence: NH 341) | |
| 101YM0800X Counselor Mental Health (Licence: MA 3790) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-09 |