| NPI | 1619252988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 3735) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 3735) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |