| NPI | 1891994307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID ACADC-90) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID 28335) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2016-10-26 |