| NPI | 1407900947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2772) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 691) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2024-08-14 |