| NPI | 1245421841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh8349) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL mac-23612) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: FL mh8349) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2007-08-07 |