| NPI | 1114145612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 460-124) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14971-132) |
| 104100000X Social Worker (Licence: WI 402) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2025-09-11 |