| NPI | 1821114836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C1482) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADC III, 95-04-154) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2016-08-08 |