| NPI | 1467665828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MA 609) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 609) |
| 106H00000X Marriage & Family Therapist (Licence: MA 339) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |