| NPI | 1740215201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA NAADAC Cert #013537) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: VA 0717000492) |
| 101YP2500X Counselor, Professional (Licence: VA 0701000320) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-07-09 |