| NPI | 1013017169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 6995-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12418) |
| 106H00000X Marriage & Family Therapist (Licence: WI 555-124) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2016-11-04 |