| NPI | 1942632526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5536) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 12080115) |
| 101YM0800X Counselor, Mental Health (Licence: SC 5536) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2013-08-06 |