| NPI | 1245207158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 12024) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 294123) |
| 106H00000X Marriage & Family Therapist (Licence: WI 271124) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2007-07-08 |