| NPI | 1447817614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 7908) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1387) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2023-06-15 |