| NPI | 1417029679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-26) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC-2642) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2008-02-12 |