| NPI | 1851332621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: GA 203) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA 973) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2007-07-08 |