| NPI | 1275710709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 994) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 3520) |
| 225C00000X Rehabilitation Counselor (Licence: MA 1108) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2008-01-28 |