| NPI | 1326040346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SD LPC#807) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA LMFT#00134) |
| 106H00000X Marriage & Family Therapist (Licence: SD LMFT#1095) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |