| NPI | 1699036111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 87000159A) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 87000159A) |
| 106H00000X Marriage & Family Therapist (Licence: IN 85000056A) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2016-07-14 |