| NPI | 1720220965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA LPC002004) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 501603) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2009-04-02 |