| NPI | 1588985584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 1949) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2010-06-14 |