| NPI | 1013153253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 4152-120) |
| 104100000X Social Worker (Licence: WI 4152-120) | |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |