| NPI | 1881613982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1861) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 466) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2025-09-11 |