| NPI | 1316117559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 711LMFT) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 711 LMFT) |
| 101YM0800X Counselor Mental Health (Licence: MA 711LMFT) | |
| 101YP2500X Counselor Professional (Licence: MA 711 LMFT) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |