| NPI | 1316971799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 00380) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA 00191) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2007-08-30 |