| NPI | 1730403205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000953) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 103-022) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2012-03-21 |