| NPI | 1588613061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 917) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 2266) |
| 106H00000X Marriage & Family Therapist (Licence: LA 457) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2007-07-08 |