| NPI | 1770609018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SC 1418) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SC 1503) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |