| NPI | 1801940424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 3809) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 98) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2009-12-30 |