| NPI | 1255541769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 647) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL 3378) |
| 106H00000X Marriage & Family Therapist (Licence: FL 2002) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |