| NPI | 1396799292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 1818) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 1960) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2007-07-08 |