| NPI | 1376704189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 570) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0137) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2008-06-24 |