| NPI | 1043570732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 102L00000X Psychoanalyst | |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2014-08-04 |