| NPI | 1659449387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 5226) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1214) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-07-08 |