| NPI | 1184735417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SD MH2083) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD LMFT1093) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-09 |