| NPI | 1619229317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000827A) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IN CII-1752) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2019-10-24 |