| NPI | 1962503490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 5685) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 6081) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |