| NPI | 1659684280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 12538) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 88219) |
| Enumeration Date | 2010-07-25 |
| Last Update Date | 2016-10-12 |