| NPI | 1043564271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NC 1007090) |
| 101YM0800X Counselor, Mental Health | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2012-11-09 |
| Last Update Date | 2015-08-26 |