| NPI | 1093943763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 673) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 583) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2009-07-01 |