| NPI | 1326510454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID 7873) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID MFT-7870) |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2020-12-08 |