| NPI | 1619106549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 2799) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |