| NPI | 1952458713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364S00000X Clinical Nurse Specialist (Licence: LA APO6313) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1595) |
| 106H00000X Marriage & Family Therapist (Licence: LA 177) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-10-19 |