| NPI | 1639114986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-407) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: ID LMFT-2743) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2007-07-08 |