| NPI | 1073669156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AL 634) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL L116) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |