| NPI | 1881947216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 102L00000X Psychoanalyst | |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2012-10-23 |