| NPI | 1437385127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 2230) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL 047) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL 222) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2024-03-15 |