| NPI | 1255319554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 000160) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 000091) |
| 106H00000X Marriage & Family Therapist (Licence: MO 30036) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2008-08-07 |