| NPI | 1710121769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 372600000X Adult Companion | |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2014-07-08 |