| NPI | 1023036878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 3044) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 902) |
| 106H00000X Marriage & Family Therapist (Licence: MA 832) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-12-27 |