| NPI | 1386805562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 855) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1384) |
| 104100000X Social Worker (Licence: MA 208208) | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2008-06-20 |