| NPI | 1669689089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WY MFT207) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV MAC NAADAC 507070) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WY LAT367) | |
| 106H00000X Marriage & Family Therapist (Licence: NV 0611) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-02-25 |