| NPI | 1730448747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 1050) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: LA 1950) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2012-05-10 |