| NPI | 1376743187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 1813) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 813) |
| 106H00000X Marriage & Family Therapist (Licence: MA 580) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2007-07-19 |