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 |