| NPI | 1891182713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: IN 87001536A) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34001491A) |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2015-04-17 |