| NPI | 1730375577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 7077) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 5079) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2592) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2014-12-02 |