| NPI | 1841455946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3779) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1166) |
| 101YM0800X Counselor, Mental Health (Licence: LA 3779) | |
| 101Y00000X Counselor (Licence: LA 1056) | |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2014-10-16 |