| NPI | 1851470132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 30) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NM 29) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-11-19 |