| NPI | 1760717227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: LA 767) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 2291) |
| 101YS0200X Counselor, School (Licence: LA 71721) | |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2009-10-15 |