| NPI | 1316195886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| 174H00000X Health Educator | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2011-04-19 |