| NPI | 1053747709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001695) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 000420) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2013-09-25 |