| NPI | 1356417265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID LCPC-219) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-3036) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2008-01-07 |