| NPI | 1710943808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AR P9201004) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AR M9903003) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-07-08 |