| NPI | 1841285053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC3531) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 10421) |
| 106H00000X Marriage & Family Therapist (Licence: TX 2415) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2012-10-10 |