| NPI | 1801224977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 14440) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2019-05-08 |