| NPI | 1922394410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A2006598) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA LR190311) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ LISAC 11522) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2011-06-22 |