| NPI | 1518303833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2472) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9307) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2023-10-27 |