| NPI | 1891053591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 373) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 263) |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2012-05-01 |