| NPI | 1699898874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 89) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 1571) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2025-09-11 |