| NPI | 1376802165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 1863) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 0011241) |
| 101YP2500X Counselor, Professional (Licence: MT 1305-LCPC) | |
| 106H00000X Marriage & Family Therapist (Licence: MT 12) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2013-12-11 |