| NPI | 1467538587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 321) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CO 321) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2016-03-07 |