| NPI | 1811134091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: PR 2097) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PR 003) |
| 106H00000X Marriage & Family Therapist (Licence: PR 2097) | |
| Enumeration Date | 2009-01-09 |
| Last Update Date | 2012-02-06 |