| NPI | 1891838454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14134) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2016-09-07 |