| NPI | 1376506014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 4574) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 582) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2007-07-08 |