| NPI | 1891772141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 2057 (LMHC)) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 916 (LMFT)) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2007-07-08 |