| NPI | 1922365691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1810139) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0261L) |
| 106H00000X Marriage & Family Therapist (Licence: AR M0708004) | |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2018-12-27 |