| NPI | 1952533135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 7427) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC 7427) |
| 101YP2500X Counselor Professional (Licence: NC 7427) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1606) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2010-04-15 |