| NPI | 1679910772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 21334-A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2017-03-08 |