| NPI | 1609972025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 44) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 308) |
| 106H00000X Marriage & Family Therapist (Licence: NE 179) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2012-03-20 |