| NPI | 1639447139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1457) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 167) |
| 106H00000X Marriage & Family Therapist (Licence: IA 374) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IA 15057) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2015-12-30 |