| NPI | 1396290359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC A12369) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC A12369) |
| 106H00000X Marriage & Family Therapist (Licence: NC 11057A) | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2016-08-19 |