| NPI | 1285755314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 685) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| 102L00000X Psychoanalyst | |
| 106H00000X Marriage & Family Therapist (Licence: MA 359) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |