| NPI | 1356688097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0413) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |