| NPI | 1992983407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 103TR0400X Psychologist Rehabilitation | |
| 103TC1900X Psychologist Counseling | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2015-08-25 |