| NPI | 1396924502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC S6948) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1295) |
| Enumeration Date | 2007-10-24 |
| Last Update Date | 2018-10-11 |