NPI | 1083908594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 265) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 40) |
106H00000X Marriage & Family Therapist (Licence: MA 149) | |
Enumeration Date | 2011-06-01 |
Last Update Date | 2011-06-01 |