NPI | 1912096520 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 0909) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 00909) |
106H00000X Marriage & Family Therapist (Licence: GA 0909) | |
Enumeration Date | 2006-10-12 |
Last Update Date | 2007-07-09 |