| NPI | 1285993527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006429) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA CAC-II 1908) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA NCAC-II 014815) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |