| NPI | 1295857019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 001241) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 000327) |
| 106H00000X Marriage & Family Therapist (Licence: MO 300048) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |