| NPI | 1861615890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC2419) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA407) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2009-09-02 |