| NPI | 1417416165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 002588) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101Y00000X Counselor | |
| 101YP2500X Counselor, Professional | |
| 106H00000X Marriage & Family Therapist (Licence: MD LCM987) | |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2024-02-07 |