| NPI | 1407851405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 1583) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 685) |
| 101YP2500X Counselor, Professional (Licence: LA 1583) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2024-05-28 |