| NPI | 1407811458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: SD SD LPC 527) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: SD SD MFT 1013) |
| 106H00000X Marriage & Family Therapist (Licence: SD SD MFT 1013) | |
| 106H00000X Marriage & Family Therapist (Licence: MN MN MFT 0758) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2007-07-09 |