| NPI | 1316025711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1040) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 5198) |
| 225A00000X Music Therapist (Licence: NC 06087) | |
| 101YM0800X Counselor Mental Health (Licence: NC 5198) | |
| 225C00000X Rehabilitation Counselor (Licence: NC 00090419) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2007-07-09 |