| NPI | 1477628931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 713) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1659) |
| 1041C0700X Social Worker, Clinical (Licence: WI 3220) | |
| 106H00000X Marriage & Family Therapist (Licence: WI 400) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2009-06-17 |