| NPI | 1013391176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103K00000X Behavior Analyst | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TR0400X Psychologist Rehabilitation | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |