| NPI | 1609287531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS TA0474) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |