| NPI | 1194051060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 7527) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR C2285) |
| 106H00000X Marriage & Family Therapist (Licence: CA 42957) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2015-10-07 |