| NPI | 1598811002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 251) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 251) |
| 251S00000X (Licence: NC MHL-016-034) | |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-10-02 |