| NPI | 1740571363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 7726920-6006) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 1021897 CADC) |
| Enumeration Date | 2011-04-30 |
| Last Update Date | 2011-04-30 |