| NPI | 1609387836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA MFT348) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: LA 203) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2019-08-13 |