| NPI | 1003027061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P9411027) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR A-215) |
| 106H00000X Marriage & Family Therapist (Licence: AR M9711036) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-07-08 |