| NPI | 1619299369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: DE 123126) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: PA PC002803) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |