| NPI | 1215065834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC4893) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE CPC 1064) |
| 106H00000X Marriage & Family Therapist (Licence: NE LMHP 1503) | |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2021-10-07 |