| NPI | 1033512751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: HI 499) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1675-12) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2017-05-02 |