| NPI | 1710029780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2016-09-29 |