| NPI | 1215029178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 99) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 1734) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2011-06-20 |