| NPI | 1700076148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1187) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 333) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3047) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2013-12-06 |