| NPI | 1750530952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 7142) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 7142) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 7142) | |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2011-05-04 |