| NPI | 1194950857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA PSY003497) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 202201) |
| 101YP2500X Counselor, Professional (Licence: GA LPC004718) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2016-02-03 |