| NPI | 1922119015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-3188) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C-1425) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT-2631) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |