NPI | 1174291272 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SD LMFT11564) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SD 21011864) |
Enumeration Date | 2021-09-02 |
Last Update Date | 2024-10-22 |