| NPI | 1487747788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 4238) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 933) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-06-12 |