| NPI | 1780994434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD 2014) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD 1022) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |