| NPI | 1740343235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC286) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ID PSY57) |
| 106H00000X Marriage & Family Therapist (Licence: ID LMFT19) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2007-07-08 |