| NPI | 1538415765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC006574) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA 232361) |
| 101Y00000X Counselor (Licence: GA 736484) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 204785) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA C0055) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |