NPI | 1629172879 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: PR 310) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR 012) |
Enumeration Date | 2006-09-11 |
Last Update Date | 2009-03-24 |