| NPI | 1336414333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LA MFT1033) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA MFT1033) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA MFT1033) | |
| 101YP2500X Counselor Professional (Licence: LA MFT1033) | |
| 101YS0200X Counselor School (Licence: LA MFT1033) | |
| 106H00000X Marriage & Family Therapist (Licence: LA MFT1033) | |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2016-03-24 |