| NPI | 1447837000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 2454) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 631) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2025-07-15 |