| NPI | 1194884650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 41) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NH 9) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |