| NPI | 1609145200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 15960) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2011-12-28 |
| Last Update Date | 2017-12-28 |