| NPI | 1639173461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC C000836) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 547) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2007-07-09 |