| NPI | 1578707212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 1946) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0280) |
| Enumeration Date | 2009-04-24 |
| Last Update Date | 2014-10-13 |