| NPI | 1770794950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NC 1668) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 1144) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH00009019) | |
| 101YP2500X Counselor, Professional (Licence: NC 4914) | |
| 106H00000X Marriage & Family Therapist (Licence: WA LF00002569) | |
| Enumeration Date | 2007-05-27 |
| Last Update Date | 2022-01-07 |