| NPI | 1235473000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 001541) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 33421) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2014-07-21 |