| NPI | 1003861683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2817) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 236) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2009-05-05 |