| NPI | 1356809511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IA 085578) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 091709) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2019-06-05 |