| 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 |