| NPI | 1710108519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 263) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC #1429) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-12-22 |