| NPI | 1710127915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AL 2380) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AL 2380) |
| 101YM0800X Counselor, Mental Health (Licence: AL 2380) | |
| Enumeration Date | 2009-02-27 |
| Last Update Date | 2009-02-27 |