| NPI | 1427196526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID 5846) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7852) |
| 106H00000X Marriage & Family Therapist (Licence: CA 45016) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2015-06-26 |