| NPI | 1740729276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 119540) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: AK 25) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2022-03-05 |