| NPI | 1609091545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OR T0525) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 16945) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-07-23 |