| NPI | 1073842266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TN 1059) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00055828) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DC ADD14039) | |
| 101Y00000X Counselor (Licence: OR 10129152) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH8935) | |
| 102L00000X Psychoanalyst (Licence: CA RP-254) | |
| 106H00000X Marriage & Family Therapist (Licence: DC LMFT000063) | |
| 106H00000X Marriage & Family Therapist (Licence: TN 842) | |
| 261QM2500X Clinic/Center, Medical Specialty | |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2024-01-15 |