| NPI | 1699117598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PR 764) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PR 14477) |
| 106H00000X Marriage & Family Therapist (Licence: PR 764) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2013-07-22 |