| NPI | 1639335813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CT 001179) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CT 000756) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2009-12-15 |