| NPI | 1063591972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 32987) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 852) |
| 101YP2500X Counselor, Professional (Licence: OH E.1901525) | |
| 106H00000X Marriage & Family Therapist (Licence: OH F.1900098) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2023-06-27 |