| NPI | 1780847038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC csac) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC csac) |
| 101YP2500X Counselor, Professional (Licence: NC csac) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2010-09-22 |