| NPI | 1356729610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LA 4485) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1149) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2015-05-07 |