| NPI | 1992224034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2017-09-10 |
| Last Update Date | 2017-09-10 |