| NPI | 1699141531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MS 2016) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MS 2016) |
| 101YM0800X Counselor, Mental Health (Licence: MS 2016) | |
| 101YP2500X Counselor, Professional (Licence: MS 2016) | |
| 106H00000X Marriage & Family Therapist (Licence: MS 2016) | |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2015-08-14 |