| NPI | 1558521906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: LA 2447) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: LA 2447) |
| 106H00000X Marriage & Family Therapist (Licence: LA 410) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2024-09-05 |