| NPI | 1730770355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 102L00000X Psychoanalyst | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2023-06-12 |