| NPI | 1265978696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |