| NPI | 1801133350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1501) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 20174) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9504) | |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2022-07-22 |