| NPI | 1962508986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NAADAC # 507172) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC 004640) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2011-11-10 |