| NPI | 1114365848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CO 989461) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 102L00000X Psychoanalyst | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2013-06-04 |