| NPI | 1770609018 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: SC 1503) | 
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 1418) | 
| Enumeration Date | 2007-03-21 | 
| Last Update Date | 2025-09-11 |