| NPI | 1467561381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C004224) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC C004224) |
| 102L00000X Psychoanalyst (Licence: NC C004224) | |
| 106H00000X Marriage & Family Therapist (Licence: NC C004224) | |
| 101YM0800X Counselor, Mental Health (Licence: NC C004224) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-12-27 |