| NPI | 1902349095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TR0400X Psychologist, Rehabilitation | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2016-11-22 |