| NPI | 1063456895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MT LCPC 1009) |
| 101Y00000X Counselor (Licence: MT LCPC1009) | |
| 106H00000X Marriage & Family Therapist (Licence: MT LCPC1009) | |
| 103K00000X Behavior Analyst | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2015-08-18 |