| NPI | 1871750364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 5374) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SC 1005205) |
| 101YM0800X Counselor Mental Health (Licence: SC 5134) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2014-02-28 |