| NPI | 1689001026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MD LC5267) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LC5267) |
| 101YM0800X Counselor, Mental Health (Licence: MD LC5267) | |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2014-05-27 |