| NPI | 1902106180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1459) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2018-03-17 |