| NPI | 1871859603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 3337) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 8466) |
| 101YP2500X Counselor Professional (Licence: NC 8466) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2015-10-16 |