| NPI | 1467476192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 000230) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT CTOOO230) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |