| NPI | 1376976308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MH3817) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2020-05-05 |