| NPI | 1508018086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: ID LMFT 2634) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC 243) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2017-05-12 |