| NPI | 1053584896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SD 588) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD LMFT1143) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |