| NPI | 1033549415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1821) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T10467A) |
| Enumeration Date | 2013-11-20 |
| Last Update Date | 2023-06-08 |