| NPI | 1710102892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC 43) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 29) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |