| NPI | 1609106608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA N0312291432) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA N0312291432) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2010-01-13 |