| NPI | 1770811747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 4582) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 1190) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2009-12-02 |