| NPI | 1265818942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 1233) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA 5756) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |