| NPI | 1154483667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SD LMFT 1042) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SD CCDCIII-01081179) |
| 101YP2500X Counselor Professional (Licence: SD LPC 741) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2009-04-13 |