| NPI | 1689001679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 002828) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CT 001055) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2015-10-28 |