| NPI | 1801068440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 6731) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |