| NPI | 1942580824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1757) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 7779) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2016-12-09 |