| NPI | 1194922872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 2849) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 275) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2011-10-04 |