| NPI | 1750622627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 1551) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC A10090) |
| Enumeration Date | 2013-03-02 |
| Last Update Date | 2015-12-22 |