| NPI | 1700062684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AL 441) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL 3580) |
| 101YP2500X Counselor, Professional (Licence: AL 3580) | |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2024-05-14 |