| NPI | 1477632073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1133) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS2027) |
| 101YP2500X Counselor, Professional (Licence: NC 1133) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-07-31 |