| NPI | 1467051953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 13807) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 13807) |
| 101Y00000X Counselor (Licence: SC 13807) | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SC 13807) | |
| 101YP2500X Counselor Professional (Licence: SC 13807) | |
| 102L00000X Psychoanalyst (Licence: SC 13807) | |
| 102X00000X Poetry Therapist (Licence: SC 13807) | |
| 1041C0700X Social Worker Clinical (Licence: SC 13807) | |
| 106H00000X Marriage & Family Therapist (Licence: SC 13807) | |
| Enumeration Date | 2020-10-26 |
| Last Update Date | 2020-10-26 |