| NPI | 1922497833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-23765) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-28156) |
| 106H00000X Marriage & Family Therapist (Licence: MT BBH-LMFT-LIC-39452) | |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2020-06-01 |