| NPI | 1972622108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MS 870) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MS 0870) |
| 106H00000X Marriage & Family Therapist (Licence: MS 000029) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2010-09-22 |