| NPI | 1679728562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 2006013051) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2006009250) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2008-11-19 |