| NPI | 1114304979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3110) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 983) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |