| NPI | 1619938537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 697) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 2983) |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2013-08-28 |