| NPI | 1215147400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 7590) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 051235) |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2022-05-16 |