| NPI | 1013196716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT2935) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-949) |
| 101YP2500X Counselor, Professional (Licence: ID LPC949) | |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2019-01-28 |