| NPI | 1538412804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SC 6510) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 93601) |
| Enumeration Date | 2012-10-23 |
| Last Update Date | 2018-01-31 |