| NPI | 1770881294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: OR 12-06-53) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2014-12-19 |