| NPI | 1306171194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MT 1365) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 002638) |
| 106H00000X Marriage & Family Therapist (Licence: MO 300130) | |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2009-10-12 |