| NPI | 1740312248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ME MF4145) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000746) |
| 106H00000X Marriage & Family Therapist (Licence: CT 001026) | |
| Enumeration Date | 2007-03-10 |
| Last Update Date | 2013-05-29 |