| NPI | 1558571026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SC 1204) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 1775) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2024-11-10 |