| NPI | 1669404935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AR P8811020) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M9710027) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |