| NPI | 1366834251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 075011) |
| Additional Taxonomies | 104100000X Social Worker (Licence: IA 075011) |
| 106H00000X Marriage & Family Therapist (Licence: IA 075011) | |
| 101YM0800X Counselor, Mental Health (Licence: IA 075011) | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-03-02 |