| NPI | 1003167198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-5100) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LAMFT-4954) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2019-08-15 |