| NPI | 1902133457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1541) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8362) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2012-11-09 |