| NPI | 1992821656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 103TA0400X Psychologist Addiction (Substance Use Disorder) | |
| 103TC1900X Psychologist Counseling | |
| 103TF0000X Psychologist Family | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2007-07-08 |