| NPI | 1851618433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TN 4913) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MS 0044) |
| Enumeration Date | 2010-04-22 |
| Last Update Date | 2022-05-25 |