| NPI | 1790801983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 000878) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 300026) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |