| NPI | 1639130370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 83) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 978) |
| 106H00000X Marriage & Family Therapist (Licence: NC 680) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2007-07-08 |