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 |