| NPI | 1972631380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 0638) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MS T0120) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2022-07-21 |