| NPI | 1760698518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 300013) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 001804) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-04-15 |