| NPI | 1881754620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1903) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 433) |
| 101YP2500X Counselor, Professional (Licence: NE 1108) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 691) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-10-26 |