| NPI | 1891116646 |
|---|---|
| Other Name | NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2013-12-20 |
| Last Update Date | 2013-12-20 |