| NPI | 1750500948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: IN 34001038A) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |