| NPI | 1033165923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 448) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: NC 448) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-09 |