| NPI | 1447210836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 2335) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 489) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC 19316) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2007-07-09 |