| NPI | 1811244296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0012269) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 11483) |
| 101YP2500X Counselor, Professional (Licence: TX 68694) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0000538) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2016-04-24 |