| NPI | 1740376409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 3565) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1207) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-06-15 |