| NPI | 1952672594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 005914) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 271261) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |