| NPI | 1447276258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 920) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: SC 453) |
| 106H00000X Marriage & Family Therapist (Licence: SC 1008) | |
| 106H00000X Marriage & Family Therapist (Licence: SC 237) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |