| NPI | 1659740918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC-370) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI CSAC 1383-08) |
| Enumeration Date | 2015-09-16 |
| Last Update Date | 2015-09-16 |