| NPI | 1750654620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1984) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC C008509) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2014-11-19 |