| NPI | 1396809539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ME MF517) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ME CC913) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2014-12-10 |