| NPI | 1932370053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MA 1277) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MA 6735) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2008-12-10 |