| NPI | 1295206555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 8087) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC ADC-2105) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2024-03-29 |