| NPI | 1710160858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: LA 2718) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 567) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2012-03-07 |