| NPI | 1578629804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: LA 1967) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: LA 1967) |
| 106H00000X Marriage & Family Therapist (Licence: LA 828) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |