| NPI | 1720250467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC C005936) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC C005936) |
| 101YM0800X Counselor, Mental Health (Licence: NC C005936) | |
| 101YP2500X Counselor, Professional (Licence: NC C005936) | |
| 101YS0200X Counselor, School (Licence: NC C005936) | |
| 102L00000X Psychoanalyst (Licence: NC C005936) | |
| 1041C0700X Social Worker, Clinical (Licence: NC C005936) | |
| 1041S0200X Social Worker, School (Licence: NC C005936) | |
| 106H00000X Marriage & Family Therapist (Licence: NC C005936) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2014-09-04 |