| NPI | 1972543056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5025) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 1101) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2009-08-31 |