| NPI | 1164967667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106H00000X Marriage & Family Therapist | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2016-12-20 |
| Last Update Date | 2016-12-20 |