| NPI | 1821053794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SD 684) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD 1021) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-01-20 |