| NPI | 1265498711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC1064) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ME MF1065) |
| 106H00000X Marriage & Family Therapist (Licence: MA 357) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-07-08 |