| NPI | 1306013958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 114) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AL 106) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2008-05-13 |