| NPI | 1629287644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL MH7315) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: FL ND39) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-03-25 |