| NPI | 1487776985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 487-132) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: WI 19-124) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |