| NPI | 1417978347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LMFT-38) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 7FI00068900) |
| 101Y00000X Counselor (Licence: PA MF000283) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2007-07-08 |