| NPI | 1568515005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 3050) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 440) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-08 |