| NPI | 1558341529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 255) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 141) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2007-07-08 |