| NPI | 1912138900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C0666) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR C0666) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2009-08-07 |