| NPI | 1861876773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 522) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-1260) |
| 101YP2500X Counselor, Professional (Licence: NE 485) | |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |