| NPI | 1720294614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: PA PC002299) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.0005486) |
| 101Y00000X Counselor (Licence: MI 6401005427) | |
| 106H00000X Marriage & Family Therapist (Licence: MI 4101006082) | |
| 106H00000X Marriage & Family Therapist (Licence: NY 000820) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2011-10-17 |