| NPI | 1538365937 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1438)  | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 73)  | 
| Enumeration Date | 2007-06-22 | 
| Last Update Date | 2014-01-02 |