| NPI | 1356459127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 07180000118) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701-002204) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717-000248) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |