| NPI | 1225236607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0251) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS 97-0011) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2009-05-27 |