| NPI | 1508847724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 1868) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA 000314) |
| 106H00000X Marriage & Family Therapist (Licence: GA 314) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2022-04-20 |