| NPI | 1003270794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 6255) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2016-04-08 |