| NPI | 1194046276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 1865) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 1642) |
| 101YP2500X Counselor, Professional (Licence: NC 613) | |
| 106H00000X Marriage & Family Therapist (Licence: NC 566) | |
| Enumeration Date | 2010-06-12 |
| Last Update Date | 2010-06-12 |