| NPI | 1902974611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1017) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 1017) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2016-04-21 |