| NPI | 1548488919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 2412) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA MFT25) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2014-01-22 |