| NPI | 1487902227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1581) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 3857) |
| 106H00000X Marriage & Family Therapist (Licence: LA 1133) | |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2014-09-16 |