| NPI | 1588020812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TX 204734) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 302348) |
| 106H00000X Marriage & Family Therapist (Licence: MN 3074) | |
| Enumeration Date | 2015-12-31 |
| Last Update Date | 2022-12-27 |