| NPI | 1710347760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5632) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1214) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2016-03-03 |