| NPI | 1164548038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 65249) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 178-003860) |
| 101YP2500X Counselor, Professional (Licence: MO 2005022222) | |
| 106H00000X Marriage & Family Therapist (Licence: MO 2005014503) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-04-30 |