| NPI | 1417388679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IN 35001812A) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: IN 35001812A) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2020-11-18 |