| NPI | 1952770935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 44.001162) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 3284) |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2017-10-30 |