| NPI | 1629014428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD LCA169) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MD LCO296) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2007-07-08 |