| NPI | 1487729760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 12272A) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: AR A0606008) |
| 101Y00000X Counselor (Licence: AR A0606008) | |
| 106H00000X Marriage & Family Therapist (Licence: AR A0606008) | |
| 171M00000X Case Manager/Care Coordinator (Licence: AR A0606008) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-01-26 |