| NPI | 1891815221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ME CC2754) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA ME18684) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2012-07-03 |