| NPI | 1710197843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 11597) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ 4125) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2014-08-29 |