| NPI | 1760561534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 317) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 313) |
| 101YP2500X Counselor, Professional (Licence: LA 313) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2025-09-11 |