| NPI | 1881938785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 1870) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 758) |
| 106H00000X Marriage & Family Therapist (Licence: LA 107) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2017-04-07 |