| NPI | 1487787693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC5) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT2659) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2007-07-08 |