| NPI | 1861560963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 071000063) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701002999) |
| 106H00000X Marriage & Family Therapist (Licence: VA 0717000980) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 770) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |