| NPI | 1740293273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 875) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 3801) |
| 101YP2500X Counselor, Professional (Licence: SC 4101) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2009-02-12 |