| NPI | 1114145612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14971-132) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 402) |
| 106H00000X Marriage & Family Therapist (Licence: WI 460-124) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |