| NPI | 1104927813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710000467) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: VA 0701001867) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000213) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |