| NPI | 1952478687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: WI 431-124) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 13090-131) |
| 1041C0700X Social Worker, Clinical (Licence: WI 2951-123) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2022-02-11 |