| NPI | 1669620209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: GA 002394) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA 002394) |
| 101YM0800X Counselor Mental Health (Licence: GA 002394) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2008-09-08 |