| NPI | 1255406542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NM 0107071) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0067182) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-10-01 |