| NPI | 1225120884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2007-07-08 |