| NPI | 1376922351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C3898) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 83809) |
| Enumeration Date | 2015-05-24 |
| Last Update Date | 2020-03-17 |