| NPI | 1881893105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 629) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI 382) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2019-10-29 |