| NPI | 1053478735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 101Y00000X Counselor | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2009-04-29 |