| NPI | 1932510500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: FL IMT 1741) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178004187) |
| 101YP2500X Counselor, Professional (Licence: IL 180008617) | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2014-05-16 |