| NPI | 1093923609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC547) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD LMFT1148) |
| 106H00000X Marriage & Family Therapist (Licence: IA 00198) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |