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 |