| NPI | 1457567992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AK 457) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 552) |
| 106H00000X Marriage & Family Therapist (Licence: AK 233) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 513) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |