| NPI | 1710075577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 2902) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 2902) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 431) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2008-05-14 |