| NPI | 1144636598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T0358) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 0481) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |