| NPI | 1720008832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1327) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4839) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2007-07-08 |