| NPI | 1699830844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 656) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 001196) |
| 1041C0700X Social Worker, Clinical (Licence: MO 003801) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-08 |