| NPI | 1164588240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA MFC36606) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA MFC36606) |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC36606) | |
| Enumeration Date | 2006-12-31 |
| Last Update Date | 2007-07-08 |