| NPI | 1235534512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family (Licence: LA 4770) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 4770) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: LA 4770) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 4770) | |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |