| 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 |