| NPI | 1588878649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |