| NPI | 1942205513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 2712) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SC 1632) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2019-04-18 |