| NPI | 1477611440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 34002465A) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |