| NPI | 1528480324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT LCPC 7589) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MT 4628) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2014-02-26 |