| NPI | 1275052896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AK 277) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AK 798) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2020-03-11 |