| NPI | 1952847691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MS 2137) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0517) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-01-18 |