| NPI | 1598163594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1517) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2014-12-08 |