| NPI | 1477614840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 1744) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 539) |
| 106H00000X Marriage & Family Therapist (Licence: TX 3919) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-03-10 |