| NPI | 1255575452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 101yao400x) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2012-03-13 |