| NPI | 1104837251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ND 428-9-1-99-237) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ND 428-9-1-99) |
| 101YP2500X Counselor Professional (Licence: ND 428-9-1-99) | |
| 106H00000X Marriage & Family Therapist (Licence: ND 428-9-1-99) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2019-09-18 |