| NPI | 1093263972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC008979) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC0089979) |
| 101YP2500X Counselor, Professional (Licence: GA LPC008979) | |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2018-04-10 |