| NPI | 1649599697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT 1412) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 36736) |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2010-05-28 |