| NPI | 1881920072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DE PC-0000625) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE CD-0000050) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2014-01-31 |