| NPI | 1346531365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 8284) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1463) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2021-03-16 |