| NPI | 1295857019 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MO 300048) | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 001241) | 
| 1041C0700X Social Worker, Clinical (Licence: MO 000327) | |
| Enumeration Date | 2007-04-04 | 
| Last Update Date | 2025-09-11 |