| NPI | 1932499449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 3564) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MA 912) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2011-04-28 |