| NPI | 1619939576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: SD LPC526) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: SD LMFT1069) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2007-07-08 |