| NPI | 1912102526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA S0606201414) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006510) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2012-04-25 |