| NPI | 1831550565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: GA C0170) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL 5774) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2016-04-19 |