| NPI | 1265946479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PR 4396) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PR 4396) |
| 101YS0200X Counselor, School (Licence: PR 1060281) | |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2019-08-06 |