NPI | 1164681730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2006012732) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 0794) |
Enumeration Date | 2008-06-08 |
Last Update Date | 2008-06-08 |