| NPI | 1376645903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 1381) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: 3584) |
| 101YP2500X Counselor, Professional (Licence: LA 1381) | |
| 106H00000X Marriage & Family Therapist (Licence: LA 625) | |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2007-07-08 |