| NPI | 1396905857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-251) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC-251) |
| 106H00000X Marriage & Family Therapist (Licence: ID LCPC-251) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2008-06-09 |