| NPI | 1548347131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MS T0115) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 042) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |