| NPI | 1508315771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12582-MH-CC) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2021-11-12 |