| NPI | 1033319157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 14052) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ 10260) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2016-01-22 |